Thoracolumbar, sacroiliac, and TMJ tests
These special tests cover the thoracic and lumbar spine, the sacroiliac joint, and the temporomandibular joint.
Thoracic spine scoliosis screening
- Adam’s forward bend test:
- The child bends forward at the waist while keeping their knees straight.
- Checks for any asymmetry or curvature in the spine.
- Positive: elevation of the ribs on one side of the spine
- The child bends forward at the waist while keeping their knees straight.
Lumbar spine
- Slump test
- Patient sits with knees flexed and neutral neck and head; progress through the following steps- passively flex head and neck, passively extend knee, passively dorsiflex ankle of limb- repeat with opposite leg
- The therapist will stop at a step if reproduction of symptoms occurs
- Tests for neurological dysfunction of the lower extremity
- Positive: reproduction of pain, paresthesias, numbness/tingling, or other neurological symptoms. This detects disc herniations or screens for sciatica by placing the nervous system under tension.
- The therapist will stop at a step if reproduction of symptoms occurs
- Patient sits with knees flexed and neutral neck and head; progress through the following steps- passively flex head and neck, passively extend knee, passively dorsiflex ankle of limb- repeat with opposite leg
- Prone instability test
- Patient prone with torso supported on the mat, legs off the edge, with both feet supported on the ground. The therapist applies posterior/anterior springing throughout the lumbar spine to identify painful segments. The therapist then instructs the patient to lift the legs off the floor and perform the same posterior/anterior springing
- Tests the instability of the lumbar spine
- Positive: pain with springing while the feet rest on the ground that decreases or resolves once the patient actively lifts the legs. This shows the patient can stabilize the segment through muscle activation, supporting a diagnosis of clinical lumbar instability that would respond to stabilization exercise.
- Patient prone with torso supported on the mat, legs off the edge, with both feet supported on the ground. The therapist applies posterior/anterior springing throughout the lumbar spine to identify painful segments. The therapist then instructs the patient to lift the legs off the floor and perform the same posterior/anterior springing
- Lumbar spine quadrant test (Kemp’s test)
- Patient standing
- The patient stands and is guided by the practitioner to maximally extend their spine, then rotate and laterally flex toward the side of the pain. The practitioner applies a gentle downward pressure
- Tests the compression of neural structures at the facet and intervertebral foramen
- Positive: pain or paresthesias in a dermatomal pattern or localized pain if facet dysfunction
- Patient standing
Neurological dysfunction
- Lower limb tension tests assist with identifying peripheral nerve injury by placing the lower limb in positions that will stress the nerve
- Prone knee flexion with hip extension tests femoral nerve
- Straight leg raise (SLR)- test sciatic and tibial nerve
- Hip: flexion (neutral rotation)
- Knee: extension
- Ankle: dorsiflexion
Sacroiliac
- Long sitting
- Patient supine with therapist palpating the medial malleolus- therapist observes alignment. The therapist then asks the patient to come to a long sitting position to observe if alignment at the medial malleolus is still present.
- Tests for leg length discrepancy due to the sacroiliac joint
- Positive: one leg observed longer when coming to a long sitting position compared to the supine position
- Patient supine with therapist palpating the medial malleolus- therapist observes alignment. The therapist then asks the patient to come to a long sitting position to observe if alignment at the medial malleolus is still present.
Temporomandibular joint (TMJ)
A bilateral synovial joint with articulation between the mandible and the cranium. The articular disc lies between areas of articulation in which there is no vascularization or neural supply. The disc (collateral) ligaments attach the disc to the condyle, so the disc moves anteriorly and posteriorly with the condyle while being kept from displacing medially or laterally. Movements of the TMJ are a combination of axis rotation and sliding movements. Types of movement are seen below:
- Elevation (closing):
- Contraction of the masseter, temporalis, and medial pterygoid muscles raises the mandible.
- Depression (opening):
- Relaxation of the elevator muscles and contraction of the lateral pterygoid, digastric, geniohyoid, and mylohyoid muscles lowers the mandible.
- Protrusion (forward movement):
- Contraction of the lateral pterygoid muscles moves the mandible forward.
- Retrusion (backward movement):
- Contraction of the posterior fibers of the temporalis muscles moves the mandible backward.
- Lateral deviation (side-to-side movement):
- Contraction of the lateral pterygoid muscle on one side moves the mandible toward the opposite side.
Special tests of TMJ
- TMJ compression
- Patient sitting or supine; therapist stabilizes the patient’s head with one hand while the other hand pushes the mandible superiorly, causing a compressive load to the TMJ
- Assess pain in the retrodiscal tissues
- Positive: pain in the TMJ
- Patient sitting or supine; therapist stabilizes the patient’s head with one hand while the other hand pushes the mandible superiorly, causing a compressive load to the TMJ